ANALYSIS

Communication breakdown adds to VA woes

WASHINGTON — Several hospitals in the Department of Veterans Affairs health care system have been the subject of scandal in the past year, ranging from unsanitary conditions in Washington to misconduct in Roseburg, Ore., and poor patient care in Manchester, N.H.

Some lawmakers say they are concerned that the problems weren’t resolved by the VA because of deep-seated communication breakdowns between local hospitals, regional leaders and the central office in Washington. Are there more issues across the country that aren’t reaching the VA secretary’s office?

Sen. Jon Tester, D-Mont., the ranking Democrat on the Senate Veterans’ Affairs Committee, wrote a letter to then-VA Secretary David Shulkin on March 9 with concerns. If the central office wasn’t aware of problems at the D.C. hospital, it’s likely oblivious to any problems in Montana or elsewhere, he wrote.

“After all, if the flow of information between two points in Washington, D.C. — less than four miles apart — is broken, you can imagine the concerns I have about communication between VA central office and the Montana VA Health System — a distance of approximately 2,200 miles,” he wrote.

Tester said the situation at the D.C. hospital “validates a concern I have had for years about the flow of information between the VA central office and the field.”

Most of lawmakers’ concerns lie with the regional level of leadership at the VA, known as Veteran Integrated Service Networks, or VISNs. There are 23 VISNs nationwide. Local hospitals and clinics report to VISNs, which are then supposed to communicate with the VA central office.

But that doesn’t always happen.

Shulkin said he was unaware of issues at the Manchester and Roseburg hospitals until they had been thrust into the public spotlight by news reports.

The Office of Special Counsel criticized the VA in January for ignoring whistleblower complaints about the Manchester hospital for months. The VA’s response was “sluggish” and “evasive,” and the agency was reluctant to acknowledge any wrongdoing, the OSC concluded.

Rep. Carol Shea-Porter, Rep. Ann Kuster and Sen. Maggie Hassan — Democrats from New Hampshire — blamed part of the problem on the leadership at the VISN level.

Following a New York Times article in January about misconduct at the Roseburg hospital, Rep. Peter DeFazio, D-Ore., said that local and VISN-level leaders ignored his requests to investigate the facility.

DeFazio and Kuster urged Shulkin to restructure VISNs or abolish them, describing them as an unnecessary level of bureaucracy.

“If VISNs cannot function at a high level that will actually perform meaningful oversight roles, I recommend the VA abolish the VISN structure and establish a stronger oversight authority,” the lawmakers said in a letter to Shulkin. “Our veterans deserve better.”

Before Shulkin was ousted last week, he had begun to address the problem. In response to the VA Inspector General report about the D.C. hospital in March, he announced a restructuring effort that would immediately bring 23 hospitals under direct oversight of the central office.

Shulkin assigned Bryan Gamble, who had been working at the Orlando VA in Florida, to oversee three regions, including parts of New England, the D.C. area and the Southwest. Shulkin said he intended to have a plan by July 1 to reorganize the VISNs.